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78A687-CE#817 12-84
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING.
JOHN A LAMBIE. COUNTY ENGINEER ADDRESS
COLEMAN W JENKINS.SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM EACH FEE OWNER
WATER CLOSET $125 4
BATH TUB 125 [ADDREssfjM-3—
I
TYTELSHOWER 125LAVATORY 125 NTRA TO
SINK 125 DDRES `DISHWASHER 125 TY y TEL N Q.J�cs'
CO TOR'S y STATE
LAUNDRY 1'UB 125 REGISTRATION N �/' COUNTY ❑
CLOTHES WASHER 125 DISTRICT NO GROUP ZONE PRCkCESSED BY
WATER HEATER 150
GAS SYSTEM OUTLETS 150 INDUSTRIAL
WASTE APPROVAL C
OUTLETS OVER S PER SYSTEM 90 INSPECTION RECORD
61
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APPROVALS DATE INSPECTOR 5 SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK /1
ROUGH PLUMBING 1 f
TOTAL FEE ovGAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ✓
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST t `
CALIFORNIA OR THAT 1 AM T LEGAL OWNER OF,AND INTEND TO
RESIDE IN THE ABOVE DESC ED R ENTIAL P E UTILITY CO NOTIFIED
-/
4
SIGNATURE 1' 1 iY •
OF PERMITTEE FINAL
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VALIDATIO4I — ,)ROBERT A WOOD
CK i M O 6 cASH /SUPERVISING MECHANICAL ENG R
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